A case of small cell carcinoma of the uterine cervix with syndrome of inappropriate antidiuretic hormone secretion and Cushing’s syndrome

DOI Web Site
  • KIDO Takeharu
    Department of Obstetrics and Gynecology, Kansai Medical University
  • MIZOKAMI Tomomi
    Department of Obstetrics and Gynecology, Kansai Medical University
  • KOHATA Akira
    Department of Obstetrics and Gynecology, Kansai Medical University
  • TSUZUKI Tomoko
    Department of Obstetrics and Gynecology, Kansai Medical University
  • MURATA Hiromi
    Department of Obstetrics and Gynecology, Kansai Medical University
  • IKUTA Akiko
    Department of Obstetrics and Gynecology, Kansai Medical University
  • OKADA Hidetaka
    Department of Obstetrics and Gynecology, Kansai Medical University
  • KANZAKI Hideharu
    Department of Obstetrics and Gynecology, Kansai Medical University

Bibliographic Information

Other Title
  • SIADH,Cushing症候群を併発した子宮頸部小細胞癌の1例
  • 症例報告 SIADH,Cushing症候群を併発した子宮頸部小細胞癌の1例
  • ショウレイ ホウコク SIADH,Cushing ショウコウグン オ ヘイハツ シタ シキュウ ケイブ ショウサイボウガン ノ 1レイ

Search this article

Description

Small cell carcinoma (SmCC) is a neoplasm characterized by differentiation into neuroendocrine carcinoma. While the female genital tract is rarely the initial site of presentation of SmCC, prognosis of SmCC of the uterine cervix is considered to be poor due to early relapse and/or metastasis to lymph nodes and internal organs. We present a case of SmCC with hormone production that initially presented in the uterine cervix. The patient, a 39-year-old woman, was examined at another clinic with primary complaints of genital bleeding, lower abdominal pain, and nausea. Pelvic examination, transvaginal ultrasonography, and magnetic resonance imaging showed diffuse enlargement of the uterine cervix, and blood work-up revealed hyponatremia. When the patient became deranged and disoriented, she was referred to our institution. Cytological examination and biopsy of the uterine cervical tumor was suggestive of SmCC. Additional laboratory examination showed hyponatremia (116 mEq/L), a hypoosmolar state (257 mOsm/L), increased urine osmolality (873 mOsm/L), and elevated antidiuretic hormone (ADH) levels (4.76 pg/ml). Fluid and saline replacement therapy improved the patient’s hyponatremia, although she showed depressive symptoms, moon-face, and hypertrichosis. Hypokalemia, elevated adrenocorticotropic hormone (ACTH) levels, and cortisone were found in both serum and urine on laboratory examinations. Considering these findings, the patient was diagnosed with stage IIB SmCC of the uterine cervix with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and ectopic ACTH syndrome under the "umbrella" of Cushing’s disease. The patient received three arterial infusions of cisplatin and epirubicin as neoadjuvant chemotherapy to reduce the tumor bulk, followed by abdominal radical hysterectomy. Postoperative histological examination confirmed the diagnosis of SmCC. After intervention, adjuvant chemotherapy with carboplatin and etoposide was continued ; however, 10 months after the initial presentation, the patient died due to diffuse metastases and septicemia, which were complications of her disease. The present case indicates the difficulty in treating advanced uterine cervical SmCC with SIADH and Cushing’s syndrome, and highlights the importance of early detection of these highly malignant tumors through screening programs. [Adv Obstet Gynecol, 67 (2) : 130-139, 2015 (H27.5)]

Journal

Keywords

Details 詳細情報について

Report a problem

Back to top